Fill out this form to nominate a driver anyone can nominate a driver. And any professional driver is eligible. Please take the time to read over the questions, gather testimonials, and mail in the completed form to the address at the bottom of the form. If you need more space to answer questions, you may attach additional sheets to the back of this form. (*denotes required field) General Information Nominee s name:* Address: City/State/Zip:* U.S. Canada Contact information (phone/e-mail):* Birthdate: UltraONE account number: Married: Yes No Spouse s Name: Has the driver been nominated before? Yes No Driver History How long they have been driving? Fleet driver* Yes No Name of fleet: If no, drivers business name:* How long driving for the current fleet or organization? Annual mileage: Career mileage: Accident free miles: Employer:* Address: City/State:* Dates: Military: Yes No Branch of service (select): Army Navy Marines Air Force Coast Guard Other Dates: Brief highlights of military career (principal duties, areas of service, citations, medals, etc.): Nominated by Name:* Relationship with nominee:* Email:* Address:* City/State/Zip:* Phone:* I hereby represent that I have perpetrated no fraud or deception in nominating this driver. I declare that the foregoing is true and accurate. Signature: 2017 TravelCenters of America. All rights reserved. Page 1 of 3
Tell us about them Read the instruction section below for the types of information that may spell out why your nominee has excellent citizenship qualities. These are suggested areas for you to consider. Each question does not need to be specifically answered. Rather, write the reasons why your nominee has excellent qualities in each. Citizenship: Citizenship encompasses areas in which a professional driver acts when he or she is around fellow employees, freight customers, dock workers, truck stop employees and motorists. It also includes the way the driver treats his/her neighbors, friends, family and community. Is this driver neat? Do they look professional? Are they polite and respectful of others? Do they lace their language with profanity when upset or do they seek solutions? Are they flexible with changes? What makes this candidate someone the trucking organization is proud of? What makes this candidate someone that his/her community and friends or family are proud of? How does the candidate stand out in the way of Citizenship as they represent themselves and the trucking industry? Safety: The safety area is comprised of items such as how many miles has this driver driven currently without an accident? Has the candidate ever been honored with any safety awards? What makes this candidate stand out with respect to their approach to driving safely? Might this candidate have saved another s life? Does this candidate have a unique approach to his truck s safety? Does the candidate sit on any safety committees? How does the candidate stand out in the way of Safety that makes them a compelling case for this award? Community Involvement: Is this candidate involved in any trucking related charities or organizations? Is the candidate involved in any organizations back in their home town? What organizations is the candidate a part of? What does the candidate do for these organizations? Are they coaches, council members, etc.? Do they volunteer when they have the opportunity to do so? What makes the candidate stand out with respect to their Community Involvement or within the industry? Leadership: Part of the other questions may provide insights into leadership but it can be addressed more specifically here. Does the candidate have any organizations whereby he/she has a leadership position? Does he/she volunteer when needed (cite examples)? Does the candidate lead by example? In what way and with what behaviors do their leadership qualities stand out? What makes this candidate stand out with respect to Leadership? 2017 TravelCenters of America. All rights reserved. Page 2 of 3
Tell us about them (cont.) Health & Wellness: Does the candidate try to live a healthy lifestyle? Has the candidate recently lost weight by living a healthier lifestyle? Are they physically active? How so? Even if they still stand to lose weight or get healthier, what efforts are they making to bring a healthier lifestyle to their lives? What makes this candidate stand out with respect to Health and Wellness? Other considerations: What other information do you want the judges to know about this candidate? What makes them an unique and worthy candidate for Citizen Driver? Testimonials: Add as many free-form testimonials from family, friends, co-workers, community members and/or and/or other leaders as desired. Testimonials, Pictures and Awards can be sent to citizendriver@robustpromotions.com, just be sure to include the name of the nominated driver in the subject line of your email. You may also mail these items to 2018 Citizen Driver Nomination, c/o Robust Promotions LLC, P.O. Box 6299, Villa Park, IL 60181. Please include the name of the nominated driver when mailing additional information. 2017 TravelCenters of America. All rights reserved. Page 3 of 3
2018 Citizen Driver Contest Official Rules NO PURCHASE OR PAYMENT NECESSARY TO ENTER OR WIN. A PURCHASE WILL NOT INCREASE YOUR CHANCE OF WINNING. CONTEST PERIOD: The nomination period for the 2018 Citizen Driver Contest (the Contest ) begins June 1, 2017 and nominations must be received by September 30, 2017 (the Nomination Period ). ELIGIBILITY: Nominee must be an over-the-road professional truck driver who is currently employed and driving at the time of the nomination and a legal resident of the United States or Canada (excluding Quebec) who is a registered member of the UltraONE or UltraONE Expediter Driver Rewards Club Programs (each, a Program ). Program registration and membership are free. To apply for a membership, call the UltraONE Customer Service line at 1-800-632-9240, or apply at a kiosk at any TravelCenters of America or Petro Stopping Centers location, or at the TA Truck Service Centers or on-line at www.ultraonerewards.com. Employees, directors and officers of TA Operating LLC (the Sponsor ), its affiliates, subsidiaries and advertising/promotion agencies and the immediate families (spouse, parent, child, sibling, grandparent, and spouse and step of each) and members of the same household of each such person are not eligible to be nominated. The Contest is void in Quebec and where prohibited by law. NOMINATION: TravelCenters of America seeks to recognize over-the-road professional truck drivers who evoke public respect for the truck driving profession. Nomination forms will be available online at www.ta-petro.com during the Nomination Period. To nominate a long haultruck driver (or a husband/wife owner/operator team), complete the nomination form and follow the directions to submit the nomination form, or you may print the nomination form and mail it to the address provided. All nomination forms (including mailed nomination forms) must be received by September 30, 2017. You may not nominate yourself. A nominee (and each nominee of a husband/wife owner/operator team) must meet all of the eligibility requirements and the nomination form must be fully completed for the nominee to be considered a qualified nominee(s). Only fully completed nominations are eligible. Proof of nomination submission will not be deemed to be proof of receipt by Sponsor. SELECTION OF SEMI-FINALISTS, FINALISTS AND GRAND PRIZE WINNERS: A review of all qualified nominees will be done and a select group of nominees will be selected based on which of the nominees best exemplify citizenship, safety, community involvement, leadership, health & wellness and/or other significant life experiences (the Citizen Driver Categories ). Selected nominees will be required to submit to a background check and those nominees who pass the background check (see below for details) will become Semi-Finalists. A select group of up to 20 Semi-Finalists will then be selected by Sponsor to be Finalists based on which of the Semi-Finalists best exemplify the Citizen Driver Categories. Finalists will then be reviewed by a panel of independent judges who will review each Finalist to select the Grand Prize winners based on the Citizen Driver Categories, and also taking into account testimonials and awards included with the nomination form. Up to six (6) Finalists will be declared by the panel of judges as Grand Prize Winners and will be invited to attend the TA/Petro 2018 Citizen Driver Award Ceremony (the Award Ceremony ) where they will be presented on stage. Grand Prize Winners will be notified by phone by February 4, 2018.
PRIZES All Semi-Finalists $25 TA/Petro gift card All Finalists In addition to the prize already received as a Semi-Finalist: $50 in TA/Petro gift cards 5,000 UltraONE points Copy of Personal Dossier reviewed by Judges Keepsake DVD of the 2018 Citizen Driver Award Ceremony Approximate Retail Value ( ARV ): $100.00 All Grand Prize Winners In addition to the prizes already received as a Semi-Finalist and Finalist: Name on a TA/Petro travel center for a period of time to be determined by Sponsor in its sole discretion (placement of signs, plaques, etc. with Grand Prize winner s name is subject to local zoning laws, space availability and other factors which may be outside Sponsor s control). Additional $50 in TA/Petro gift cards An additional 5,000 UltraONE bonus points $750 travel voucher to attend the Award Ceremony or economy class airfare for two (2) to the Award Ceremony from a gateway airport $250 for travel expenses Hotel accommodations for two (2) nights Two (2) $250 Maui Jim Gift Certificates Honored live on stage at the Award Ceremony TA/Petro Swag Bag (includes shirts, Ball Caps, etc.) * Unveiling Ceremony for Grand Prize Winner and up to 30 guests at the TA/Petro travel center named after Grand Prize Winner in May/June 2018 ARV: $3,000.00 Each Grand Prize winner will be asked to list five (5) available TA/Petro travel centers they would like named in their honor (1-5 in order of preference) and Sponsor will select one of those travel centers in its sole discretion. Franchise owned locations may not be eligible. A travel center shall remain named in honor of a Grand Prize Winner for a period of time to be determined by Sponsor in its sole discretion. Sponsor may remove a Grand Prize winner s name from the designated travel center at any time, for any reason, in Sponsor s sole discretion. Sponsor may remove a Grand Prize winner s name from the designated travel center due to any action or conduct by a Grand Prize winner (including past or present action or conduct) that is illegal, immoral or in any way negatively affects the Sponsor s image by virtue of the association between a Grand Prize winner and Sponsor, as determined by
Sponsor s sole discretion, as well as if a Grand Prize winner endorses any competitor of the Sponsor. This element of the prize has no cash value and no Grand Prize winner will be entitled to any compensation if his/her name is removed from a travel center. A travel center that has been named for the winner of a previous Citizen Driver contest is not considered to be an available travel center, unless otherwise determined by Sponsor. Prizes are non-transferable (if a Nominee is deceased at the time a prize is awarded, the prize will be forfeited) and no substitutions or cash redemptions will be made, and must be accepted as awarded. However, Sponsor reserves the right to substitute a prize of comparable or greater value. UltraONE Points are subject to the UltraONE Driver Rewards Club Program Official Rules available at www.ultraonerewards.com. All taxes on prizes are the sole responsibility of the winners. NOTIFICATION AND VERIFICATION: All potential Semi-Finalists, Finalists, and Grand Prize winner(s) will be notified via phone (using the phone number provided during registration). The Sponsor will attempt to contact nominees via telephone, Monday-Friday between 9:00 AM ET and 6:00 PM ET. If the Sponsor representative is unable to speak directly with the selected nominee after 7 attempts within a 7-day period or Sponsor is unable to contact the nominee due to an invalid, incorrect or bogus phone number, the nomination will be deemed null and void. Before being declared a winner, the potential winners (or their parent/legal guardian if an eligible minor winner) will required to sign a standard Declaration of Eligibility/Confidentiality form (or, for Canadian Residents, a Declaration and Complete Release and Waiver form), confirming understanding, acceptance and compliance with these Official Rules, acceptance of the prize as offered and a release releasing Sponsor and the Contest Entities (as defined below) with respect to any and all injuries, accidents, loss or misfortunes related to the conduct of the Contest, awarding of the prize, and use and enjoyment of the awarded prize. All guests of Winner must also sign a Liability and Publicity Release before travel arrangements will be booked. Said form(s) must be signed and returned within 10 days from receipt date, or prize may be forfeited. If a potential winner is found to be ineligible, declines to accept the prize, or in the event that a prize confirmation or prize is returned undeliverable, the prize will be forfeited and, at the Sponsor s sole discretion, prize may be awarded to an alternate winner. Potential winners (or parent/legal guardian where applicable) may be required to furnish proof of identification. If a potential Grand Prize winner resides in the United States he/she must complete a W9 form before receiving the prize. If the W9 form is not signed and returned within 10 days from the receipt date, the winner forfeits the said prize and an alternate potential winner may be selected. Winner(s) will receive a 1099 tax form at the end of that year for the value of the prize. Nominees agree to keep their status as a potential Grand Prize winner confidential and not to disclose this to anyone except immediate family members and/or employers (provided they also agree not to disclose nominee s status as a potential Grand Prize winner), until such time as Sponsor publicly announces the Grand Prize winner(s) at the 2018 TA/Petro Award Ceremony. Nominees agree that if their status as a potential Grand Prize winner is disclosed by themselves, any immediate family members or employers, nominee may be disqualified and, if disqualified, will forfeit the Grand Prize. Background Check: Selected nominees will be required to submit to, and cooperate in, a confidential background check to confirm eligibility and to help ensure that the use of any such person in advertising or publicity for the Contest will not bring Sponsor into public disrepute, contempt, scandal or ridicule or reflect unfavorably on the Contest or the Sponsor as determined by Sponsor in its sole discretion. Selected nominees must agree to such background check as a condition of being declared a Semi-Finalist, and understand and agree that Sponsor may disqualify them based on the results of the background check, at Sponsor s sole discretion. For husband/wife owner/operator teams, both individuals must submit to and pass the background check for the team to move forward in the Contest (one team member
may not move forward without the other). Background check intake forms will be sent via email. Failure to return the intake forms as required will result in forfeiture of the opportunity to be a Semi-Finalist and such nominee will be removed from further consideration in the Contest. Sponsor is not responsible for lost, late, illegible, incomplete, invalid, unintelligible, misdirected, technically corrupted or garbled nominations, which will be disqualified, or for problems of any kind, whether mechanical, human or electronic. Sponsor, its affiliates, subsidiaries and advertising/promotion agencies (the Contest Entities ) shall not be held responsible for any delays in awarding prizes for any reason outside of their control. By agreeing to allow a nomination to proceed for consideration by the judges, nominees must fully and unconditionally agree to be bound by these Official Rules and the decisions of Sponsor, which will be final and binding in all matters relating to the Contest. If you do not wish to have your nomination considered further, please call 800-925-5732 to Opt-out of the Contest within 20 days of receipt of Notice of Nomination letter. GENERAL TERMS: By agreeing to allow his/her nomination to proceed for consideration by the judges, a nominee agrees (a) to release Sponsor and the Contest Entities from any and all liability, loss or damage incurred with respect to the awarding, receipt, possession, and/or use or misuse of any prize, (b) under no circumstances will nominees be permitted to obtain awards for, and nominees waive all rights to claim, punitive, incidental, consequential, or any other damages, other than for actual out-of-pocket expenses; and (c) all causes of action arising out of or connected with this Contest, or any prize awarded, shall be resolved individually, without resort to any form of class action. In no event will the Sponsor be liable for more than the maximum potential number of prizes stated in the chart above. Sponsor reserves the right in its sole discretion to cancel, modify or suspend this Contest at any time if fraud, technical failures, including any network server or hardware failure, viruses, bugs, errors in programming, or any other errors or other causes corrupt the administration, security, integrity or proper play of the Contest. Any attempt by any individual to deliberately damage or undermine the legitimate operation of this Contest, including but not limited to any fraudulent claims, is a violation of criminal and civil laws. Should such an attempt be made, Sponsor reserves the right to seek remedies and damages from any such individual, to the fullest extent permitted by law, including criminal prosecution. Participants engaging in any of the foregoing activities may be disqualified and will forfeit any prize(s) won. In the event of any conflict between any Contest details contained in these Official Rules and Contest details contained in Contest materials (including but not limited to point of sale, television, and print advertising, and other Contest media), the details of the Contest as set forth in these Official Rules and the decisions of the Sponsor shall prevail. Sponsor and its agents are not responsible for broadcasting, telephone system, interactive voice recording, electronic equipment, computer, software or other system errors, system failures or technical difficulties. Sponsor reserves the right, at its sole discretion, to disqualify any individual (and his/her nomination, manual or electronic) who Sponsor determines to be in violation of these Official Rules. All issues and questions concerning the construction, validity, interpretation and enforceability of these Official Rules, or the rights and obligations of a nominee and Sponsor in connection with the Contest, shall be governed by, and construed in accordance with, the substantive laws of the State of Ohio without regard to Ohio conflicts of law principles. All nominees consent to the jurisdiction and venue of the federal, state and local courts for Westlake, Ohio. The invalidity or unenforceability of any provision of these Official Rules shall not affect the
validity or enforceability of any other provision. In the event that any provision is determined to be invalid or otherwise unenforceable or illegal, these Official Rules shall otherwise remain in effect and shall be construed in accordance with their terms as if the invalid or illegal provision were not contained herein. Sponsor s employees are not authorized to waive, modify or amend any provision or provisions of these Official Rules in any manner whatsoever. Personal information collected in connection with this Contest will only be used for the purposes of administering the Contest, as described above. WINNERS LIST REQUEST: For a list of Grand Prize winners, send a self-addressed, stamped envelope, for receipt by 2/26/18, to: Robust Promotions LLC, Attn: 2018 Citizen Driver Contest Winners List, P.O. Box 6299, Villa Park, IL 60181. Canadian residents may omit return postage. Winner s List will be sent out after the 2018 Citizen Driver Award Ceremony. This Contest is solely sponsored by TA Operating LLC, 24601 Center Ridge Road, Westlake, OH 44145-5639